腹腔镜治疗成年人隐匿性腹股沟疝的临床研究

Clinical study about laparoscopic treatment of occult inguinal hernia in adults

目的:分析腹腔镜一侧疝修补术患者对侧隐匿性腹股沟疝的存在概率及其危险因素评估,以判断需行双侧腹股沟区探查的患者范围。方法:回顾分析2014年至2015年因腹股沟疝就诊且行腹腔镜疝修补术的174例患者的临床资料,其中160例行单侧疝修补术的同时探查对侧腹股沟区,术后随访24~36个月,记录隐匿性疝、异时性对侧疝及手术并发症发生率。结果:完成双侧腹股沟区探查的患者中15例合并隐匿性对侧腹股沟疝,1例失访,余者中位随访29个月,6例(6/144)术中确认"健康"的对侧出现了腹股沟疝。术后发生血清肿2例、复发1例、网片移位1例、慢性疼痛5例,1例中转开放手术,未发生手术部位感染、肠管损伤、输精管与血管损伤。结论:对于高龄、男性、左侧、疝环缺损较大者,出现隐匿性对侧腹股沟疝的概率较高,建议术中行双侧腹股沟区探查,并根据患者具体情况决定是否行预防性对侧疝修补术。双侧预防性修补是安全的。

Objective ：The purpose of this study is to evaluate the incidence of occult contralateral inguinal hernia （OCH） dur- ing laparoscopic inguinal hernia repairs （LIHR） , to mark the risk factors and judge which kind of patients need bilateral inguinal explo- ration. Methods ：The results of 174 patients who underwent laparoscopic inguinal hernia repair in Tongde Hospital of Zhejiang Province during the period of 2014-2015 were retrospectively analyzed. 160 patients among them underwent bilateral groin exploration. The occur- rence rate of OCH and metachronous contralateral inguinal hernia were calculated respectively. Meanwhile, the incidence of operative complications was also assessed over a period of following-up ranging from 24 to 36 months. Results： There was one case loss of follow- ing-up. 15 patients （15/160） who completed bilateral exploration were diagnosed as OCH during operation. 6 patients （6/144） under- went unilateral repair （though they were given bilateral groin exploration and considered contralateral side ＂healthy＂） developed a her- nia in median follow-up of 29 months. Operative complications were summarized as follows ： two cases of seroma, one case of recurrence, one case of mesh shifting and five cases of chronic pain. In addition, one case was transferred to open surgery. There was no surgical site infection,intestinal injury,vas deferens injury or blood vessels injury. Conclusions：There is higher incidence of OCH reported in the elder/male/the left side/the greater defect of hernia ring. For these patients, bilateral inguinal exploration is recommended and prophy- lactic bilateral hernia repair is necessary and safe according to the findings of laparoscopic exploration.